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Aspirin Desensitization in the Office Setting
AB222 Abstracts
J ALLERGY CLIN IMMUNOL FEBRUARY 2011
855
IgG and IgG4 Isotype Antibodies to Fel d 1 In Allergic and Non-allergic Students (n5963): Relationship to Symptoms of Asthma T. A. E. Platts-Mills1, B. Lundback2, J. M. Roper1, M. Mori1, E. Ronmark2; 1University of Virginia, Charlottesville, VA, 2University of Umea, Umea, SWEDEN. RATIONALE: Previous data on 963 randomly chosen sera from a cohort of 3,400 children in northern Sweden showed that the titer of IgE antibodies to cat, dog, and horse allergens was a major predictor of asthma symptoms. By contrast, neither high titer IgG antibodies nor cat ownership influenced symptoms. METHODS: Sera with IgG to Fel d 1 (n5100) were assayed for IgG4 using a two step radio-immunoprecipitation assay (RIPA). This assay uses a monoclonal anti-IgG4 (Sigma Aldrich) and a precipitation with goat antimouse IgG, fully absorbed against human IgG. RESULTS: Among patients with elevated IgG ab to Fel d 1, the presence of IgG4 correlated significantly with titer of IgG and was associated with cat ownership. Among 100 students who had high titer IgG to Fel d 1, the prevalence of high IgG4 ab to Fel d 1 was not significantly related to the presence of IgE ab to Fel d 1 (16/55 in negative sera vs. 10/45 in IgE positive sera, p50.4 n.s.). However, among the cat-allergic students, the presence of high IgG4 was inversely correlated with wheezing (5/16 vs. 19/29, p50.027). Among those who did not have a cat at home, the numbers of sera with high titer IgG were too low to analyze. CONCLUSIONS: Among students with high IgG ab to Fel d 1, the presence of high titer IgG4 ab was related to decreased prevalence of wheeze among allergic subjects, but this ab was equally common among the non-allergic subjects.
Aspirin Desensitization in the Office Setting R. S. Dunn1, R. W. Hendershot2; 1University of Utah School of Medicine, Salt Lake City, UT, 2Intermountain Health Care, Salt Lake City, UT. RATIONALE: Our objective is to present a one-day ASA desensitization protocol that is safely employed in the office setting. METHODS: We conducted a retrospective chart review of 15 candidates with previously diagnosed triad asthma (bronchospasm, chronic sinusitis, nasal polyps, ASA-induced exacerbations) that ranged from mild to severe, desensitized to ASA over one day in an outpatient setting. Patients were initially treated with ketorolac nasally and then given increasing doses of oral ASA with the final dose that first day being 325mg. During treatment, all patients were closely monitored and complications were immediately treated. RESULTS: Fifteen patients were treated, with a mean treatment time of 10.3 clinic hours, ranging from 8.0-15.5 hours, and at a mean cost of $2667.70. Of the 15 patients treated, none required epinephrine. A major complication was defined as hypotension or decrease in FEV1 >20%. Three patients had a decrease in FEV1 >20%, and none became hypotensive. Four patients (27%) had minor complications (facial flushing (1), flushing with urticaria (1), dyspnea (1), rash with throat swelling (1)), all of which resolved with interventional medication. Eleven patients (73%) have continued with post-treatment aspirin, and they are currently followed with routine clinic visits. CONCLUSIONS: Following our protocol, aspirin desensitization for the treatment of AERD can be accomplished safely and efficaciously in the outpatient setting in less time and at a lower cost when compared to current inpatient treatment protocols.
856
858
TUESDAY
Association between Eosinophilic Airway Inflammation and Persistent Airflow Limitation in Asthmatic Children Y. Lee1,2, H. Lee3, K. Kim1,2, M. Sohn1,2, K. Kim1,2; 1Yonsei University College of Medicine, Seoul, Korea, Seoul, KOREA, REPUBLIC OF, 2Institute of Allergy, BK21 Project for Medical Science, Research Center for Human Natural Defense System, Seoul, KOREA, REPUBLIC OF, 3 Kwandong University College of Medicine, Goyang, KOREA, REPUBLIC OF. RATIONALE: Eosinophilic airway inflammation contributes to persistent airflow limitation in adults with severe asthma. We aimed to evaluate the association between eosinophilic inflammation in induced sputum and pulmonary function, and persistent airflow limitation in children METHODS: A total of 92 asthmatic children and 72 control children were enrolled in this study. Eosinophil count (%) and eosinophil cationic protein (ECP) levels were measured in induced sputum. We performed spirometry and methacholine challenge test while measuring total eosinophil count, total serum IgE, and serum ECP in all subjects. Subjects with persistent airflow limitation were defined as the patients with postBD FEV1/FVC below the lower limit of controls, which is subtraction of 2 standard deviation from the mean ratio. RESULTS: Asthmatic children had significantly higher levels of sputum eosinophils (18.1 6 21.5 vs. 0.5 6 1.3%, P < .001) and sputum ECP (2.3 6 0.7 vs. 1.6 6 0.6 log ug/L, P < .001) compared to controls. No differences in sputum eosinophils and ECP among 4 asthmatic groups divided by the degree of persistent airflow limitation. Sputum ECP level had statistically significant inverse correlation with postbronchodilator (postBD) FEV1 (r 5 -0.307, P 5 .001) and postBD FEV1/FVC (r 5 -0.286, P 5 .002), whereas sputum eosinophils didn’t show any correlation with postBD FEV1 and postBD FEV1/FVC. CONCLUSIONS: Our findings suggest that sputum eosinophilic inflammation, especially ECP, is associated with pulmonary function and persistent airflow limitation, which is manifested by low postBD FEV1 and postBD FEV1/FVC.
857
The Asthma Control Test (ACT) Cutoff for Asthma Control May Be Higher in Hispanic Children Y. Shi1, A. S. Aledia1, J. T. Nguyen1, A. V. Tatavoosian1, S. C. George1,2, S. P. Galant3; 1Biomedical Engineering, University of California, Irvine, Irvine, CA, 2Chemical Engineering, University of California, Irvine, Irvine, CA, 3Children’s Hospital of Orange County, Orange, CA. RATIONALE: The Asthma Control Test (ACT) is a validated measure of asthma control with a score of 20 or above defined as controlled according to current American Thoracic Society (ATS) guidelines. However, different cutoffs may exist in different ethnic populations. METHODS: ACT (in English and Spanish) scores and physicians’ assessment of asthma control in 98, 6 to 17 year old mild-to-moderate asthmatic children were collected. These children were separated into 4 groups based on their age and ethnicity: Group 1 Hispanic 4-11 years (n535); Group 2 _12 years (n538); Group 3 non-Hispanic 4-11 years (n511); Hispanic > _12 years (n514). Receiver Operator Characteristics Group 4 non-Hispanic > curves were used to determine the optimized cutoffs for each group. RESULTS: Student t-test showed significant differences of ACT scores between controlled and non-controlled in all 4 groups (p<0.05). The best cutoff was 23 for controlled asthma in Hispanics for both age groups of _12 4-11 year olds (Sensitivity50.72, Specificity50.76, P50.004) and > (Sensitivity50.83, Specificity50.8, P5631025). For non-Hispanics, the best cutoff for 4-11 years old was 21 (Sensitivity51.00, Specificity51.00, _12 (Sensitivity50.80, Specificity51.00, P50.01). P50.01) and 20 for > Hispanic children have a 3 points higher ACT cutoff compared to ATS guidelines, and a 2 to 3 point difference between Hispanics and non-Hispanics. CONCLUSIONS: These preliminary data suggest that Hispanic children who are inclined to under report their asthma symptoms, may have an elevated ACT cutoff for control compared to non-Hispanic children.
J ALLERGY CLIN IMMUNOL FEBRUARY 2011
855
IgG and IgG4 Isotype Antibodies to Fel d 1 In Allergic and Non-allergic Students (n5963): Relationship to Symptoms of Asthma T. A. E. Platts-Mills1, B. Lundback2, J. M. Roper1, M. Mori1, E. Ronmark2; 1University of Virginia, Charlottesville, VA, 2University of Umea, Umea, SWEDEN. RATIONALE: Previous data on 963 randomly chosen sera from a cohort of 3,400 children in northern Sweden showed that the titer of IgE antibodies to cat, dog, and horse allergens was a major predictor of asthma symptoms. By contrast, neither high titer IgG antibodies nor cat ownership influenced symptoms. METHODS: Sera with IgG to Fel d 1 (n5100) were assayed for IgG4 using a two step radio-immunoprecipitation assay (RIPA). This assay uses a monoclonal anti-IgG4 (Sigma Aldrich) and a precipitation with goat antimouse IgG, fully absorbed against human IgG. RESULTS: Among patients with elevated IgG ab to Fel d 1, the presence of IgG4 correlated significantly with titer of IgG and was associated with cat ownership. Among 100 students who had high titer IgG to Fel d 1, the prevalence of high IgG4 ab to Fel d 1 was not significantly related to the presence of IgE ab to Fel d 1 (16/55 in negative sera vs. 10/45 in IgE positive sera, p50.4 n.s.). However, among the cat-allergic students, the presence of high IgG4 was inversely correlated with wheezing (5/16 vs. 19/29, p50.027). Among those who did not have a cat at home, the numbers of sera with high titer IgG were too low to analyze. CONCLUSIONS: Among students with high IgG ab to Fel d 1, the presence of high titer IgG4 ab was related to decreased prevalence of wheeze among allergic subjects, but this ab was equally common among the non-allergic subjects.
Aspirin Desensitization in the Office Setting R. S. Dunn1, R. W. Hendershot2; 1University of Utah School of Medicine, Salt Lake City, UT, 2Intermountain Health Care, Salt Lake City, UT. RATIONALE: Our objective is to present a one-day ASA desensitization protocol that is safely employed in the office setting. METHODS: We conducted a retrospective chart review of 15 candidates with previously diagnosed triad asthma (bronchospasm, chronic sinusitis, nasal polyps, ASA-induced exacerbations) that ranged from mild to severe, desensitized to ASA over one day in an outpatient setting. Patients were initially treated with ketorolac nasally and then given increasing doses of oral ASA with the final dose that first day being 325mg. During treatment, all patients were closely monitored and complications were immediately treated. RESULTS: Fifteen patients were treated, with a mean treatment time of 10.3 clinic hours, ranging from 8.0-15.5 hours, and at a mean cost of $2667.70. Of the 15 patients treated, none required epinephrine. A major complication was defined as hypotension or decrease in FEV1 >20%. Three patients had a decrease in FEV1 >20%, and none became hypotensive. Four patients (27%) had minor complications (facial flushing (1), flushing with urticaria (1), dyspnea (1), rash with throat swelling (1)), all of which resolved with interventional medication. Eleven patients (73%) have continued with post-treatment aspirin, and they are currently followed with routine clinic visits. CONCLUSIONS: Following our protocol, aspirin desensitization for the treatment of AERD can be accomplished safely and efficaciously in the outpatient setting in less time and at a lower cost when compared to current inpatient treatment protocols.
856
858
TUESDAY
Association between Eosinophilic Airway Inflammation and Persistent Airflow Limitation in Asthmatic Children Y. Lee1,2, H. Lee3, K. Kim1,2, M. Sohn1,2, K. Kim1,2; 1Yonsei University College of Medicine, Seoul, Korea, Seoul, KOREA, REPUBLIC OF, 2Institute of Allergy, BK21 Project for Medical Science, Research Center for Human Natural Defense System, Seoul, KOREA, REPUBLIC OF, 3 Kwandong University College of Medicine, Goyang, KOREA, REPUBLIC OF. RATIONALE: Eosinophilic airway inflammation contributes to persistent airflow limitation in adults with severe asthma. We aimed to evaluate the association between eosinophilic inflammation in induced sputum and pulmonary function, and persistent airflow limitation in children METHODS: A total of 92 asthmatic children and 72 control children were enrolled in this study. Eosinophil count (%) and eosinophil cationic protein (ECP) levels were measured in induced sputum. We performed spirometry and methacholine challenge test while measuring total eosinophil count, total serum IgE, and serum ECP in all subjects. Subjects with persistent airflow limitation were defined as the patients with postBD FEV1/FVC below the lower limit of controls, which is subtraction of 2 standard deviation from the mean ratio. RESULTS: Asthmatic children had significantly higher levels of sputum eosinophils (18.1 6 21.5 vs. 0.5 6 1.3%, P < .001) and sputum ECP (2.3 6 0.7 vs. 1.6 6 0.6 log ug/L, P < .001) compared to controls. No differences in sputum eosinophils and ECP among 4 asthmatic groups divided by the degree of persistent airflow limitation. Sputum ECP level had statistically significant inverse correlation with postbronchodilator (postBD) FEV1 (r 5 -0.307, P 5 .001) and postBD FEV1/FVC (r 5 -0.286, P 5 .002), whereas sputum eosinophils didn’t show any correlation with postBD FEV1 and postBD FEV1/FVC. CONCLUSIONS: Our findings suggest that sputum eosinophilic inflammation, especially ECP, is associated with pulmonary function and persistent airflow limitation, which is manifested by low postBD FEV1 and postBD FEV1/FVC.
857
The Asthma Control Test (ACT) Cutoff for Asthma Control May Be Higher in Hispanic Children Y. Shi1, A. S. Aledia1, J. T. Nguyen1, A. V. Tatavoosian1, S. C. George1,2, S. P. Galant3; 1Biomedical Engineering, University of California, Irvine, Irvine, CA, 2Chemical Engineering, University of California, Irvine, Irvine, CA, 3Children’s Hospital of Orange County, Orange, CA. RATIONALE: The Asthma Control Test (ACT) is a validated measure of asthma control with a score of 20 or above defined as controlled according to current American Thoracic Society (ATS) guidelines. However, different cutoffs may exist in different ethnic populations. METHODS: ACT (in English and Spanish) scores and physicians’ assessment of asthma control in 98, 6 to 17 year old mild-to-moderate asthmatic children were collected. These children were separated into 4 groups based on their age and ethnicity: Group 1 Hispanic 4-11 years (n535); Group 2 _12 years (n538); Group 3 non-Hispanic 4-11 years (n511); Hispanic > _12 years (n514). Receiver Operator Characteristics Group 4 non-Hispanic > curves were used to determine the optimized cutoffs for each group. RESULTS: Student t-test showed significant differences of ACT scores between controlled and non-controlled in all 4 groups (p<0.05). The best cutoff was 23 for controlled asthma in Hispanics for both age groups of _12 4-11 year olds (Sensitivity50.72, Specificity50.76, P50.004) and > (Sensitivity50.83, Specificity50.8, P5631025). For non-Hispanics, the best cutoff for 4-11 years old was 21 (Sensitivity51.00, Specificity51.00, _12 (Sensitivity50.80, Specificity51.00, P50.01). P50.01) and 20 for > Hispanic children have a 3 points higher ACT cutoff compared to ATS guidelines, and a 2 to 3 point difference between Hispanics and non-Hispanics. CONCLUSIONS: These preliminary data suggest that Hispanic children who are inclined to under report their asthma symptoms, may have an elevated ACT cutoff for control compared to non-Hispanic children.